Healthcare Provider Details

I. General information

NPI: 1205826187
Provider Name (Legal Business Name): DALLAS M BONDHUS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DALLAS M POMEROY PA

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 ADA AVE STE 302
CONWAY AR
72034-4985
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-932-0352
  • Fax: 501-932-0354
Mailing address:
  • Phone: 501-852-1363
  • Fax: 501-852-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 294 AR
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: